Tuesday, January 31, 2012

Wheat Again

The USDA has published this chart of U.S. consumption of wheat flour between 1830 and 2008.





Before 1850, U.S. consumption of wheat was lower than between 1850 and 1910.  The USDA explains:

"Wheat production was difficult in New England and in much of the South in the colonial era (1600s and 1700s), making wheat flour too expensive for regular use. High transportation costs also made long-distance transport of wheat and flour from regions better suited for wheat growing unprofitable. Therefore, colonists in these regions turned to other crops, especially corn. The wealthy were the principal consumers of wheat bread."

In the U.S., wheat flour (and thus wheat bread) consumption peaked in the late 19th century at about 220 pound per capita per annum.  That means that in the late 19th century, U.S. citizens were consuming an average of about 10 ounces of wheat flour daily.

That would provide about 950 kcalories, 37 g protein, and 200 g carbohydrate from whole wheat flour alone.   It is equivalent to consuming 12 slices of whole wheat bread daily.

About 1910 the per capita wheat flour consumption dropped below 200 pounds, and now it is about 150 pounds per annum, so we have seen a 32 percent drop in wheat flour consumption since the late 19th century.

So, during the 20th century, what replaced grain consumption?  The USDA says :

"Historically, economic development has been accompanied by the substitution of meat for grain in the diet, and this was true in the United States starting in the 1870s."

The substitution of meat for grains as a consequence of economic development represents part of what nutritionists have called the  nutrition transition ,  which Popkin characterizes here :

"Major dietary change includes a large increase in the consumption of fat and added sugar in the diet, often a marked increase in animal food products contrasted with a fall in total cereal intake and fiber."
Put another way, up until the late 19th century, the U.S. was an agrarian nation.  Agrarian nations typically derive most of their sustenance from cereal grains and this was true of the U.S. for its first 100 years, during which corn and wheat provided the majority of calories consumed by the majority of people.

So far as I can tell, rates of obesity, diabetes, and cardiovascular disease in the U.S. went up during a time when consumption of wheat and corn was well below that of the late 19th century.

According to an article by B.C. Curtis posted on the Food and Agriculture Organization website, the French consume almost twice as much wheat per capita as people of the United States.

According to World Health Organization data, the U.S. has about 2.5 times as many heart disease deaths as France.

France also has an obesity rate one-third of that of the U.S.A..

It doesn't look like consumption of bread increases the risk of heart disease or obesity in France.

We do have evidence indicating that whole grains including whole wheat protect against heart disease.

Groen (pdf) studied the effect of dietary wheat bread on serum cholesterol.  He found first that Trappist monks, Yemenite Jews, and Arab Bedouins consumed an average of 600, 500, and 750 g of bread daily, compared to an average of 150 g bread daily in a Western diet, but the bread eaters had low serum cholesterol levels and very low risk of ischemic heart disease.



The Bedouins consumed the most bread (750 g daily) and the least animal protein (5 g daily) and total fat (38 g) and had the lowest serum cholesterol.



One slice of bread weighs about 30 g, so the Trappists ate about 20 slices daily, the Yemenites about 17 slices, and the Bedoins about 25 slices daily, compared to about 5 slices in the typical Western diet.  These levels of bread intake are common among people who eat bread as a staple food.

Groen compared the effects on serum cholesterol of low-fat, low-sugar diets  in which most of the protein came from animal sources, or most of the protein came from wheat gluten.  The study suggested that a gluten-rich diet may produce a lower cholesterol level than one based on animal protein.

Groen also found that replacing bread with equal caloric amounts of sugar raised serum cholesterol.





46 comments:

Mert Guney said...

Very good article!

Jimmy Gee said...

So what are you saying? The lipid hypothesis is correct?

"Groen compared the effects on serum cholesterol of low-fat, low-sugar diets in which most of the protein came from animal sources, or most of the protein came from wheat gluten. The study suggested that a gluten-rich diet may produce a lower cholesterol level than one based on animal protein."

Again, you seem to be isolating one variable (wheat) and ignoring the potential for other factors. Gross level, general stats, used to summarize equally general associations are just that - general and not definitive or conclusive.

Bog said...

Thanks Don for rooting out the paleo/low-carb insanity. These sick twisted fad diet pushers do not even bother to make a rudimentary research to test their perverse hypotesis.

If grains cause autoimmune diseases, then why does data shows the more grains the less autoimmune diseases. ( I am referring the Central-Africa and rural Asia where the consumption of grains have typically made around 70% calories and yet we do not anything even close to a chronic disease).

Keep up the good work, Don.

WoLong said...

These wheat consumption data, do we know if the consumption was due to human or other purposes?

Don said...

Jimmy Gee,

Here's what I would say: We have an enormous and growing body of data that supports the lipid hypothesis. It is the best supported explanation for cardiovascular disease over the past 60 years or so. The data is strong enough to say that diets high in sugars, fats and animal protein promote diseases of affluence, whilst diets low in sugars, fats and animal protein protect against those diseases.

You quote my statements about Groen, who specifically looked at the effect of wheat bread on serum cholesterol. It was in fact the variable that he isolated in his studies, i.e. he controlled the amount of bread consumed.

As for the general data, they go directly counter to claims that wheat causes heart disease and obesity. If wheat causes these problems then it should show up in a comparison of two populations, one of which consumes nearly twice as much wheat as the other. On the contrary, the data points in exactly the opposite direction, i.e. not even the weakest kind of data (epidemiological) supports the hypothesis that wheat causes heart disease.

Then Groen performed a clinical trial that isolated wheat as a variable, and again showed that eating more wheat (and less animal protein and fat) resulted in a reduction of a major risk factor for cardiovascular disease, total cholesterol.

This is science. The epidiemiology suggests that wheat is a protective factor. So Groen does a clinical trial and confirms that a diet high in wheat reduces risk factors.

People have been doing these types of studies now for more than 50 years, with the bulk of data, both epidemiological and clinical trial, supporting the lipid hypothesis.

WoLong,

Almost all wheat is used for human consumption. According to this Kansas Wheat website, bottom of page:

U.S. TOTAL USE

50% Exports
36% Food
10% Livestock feed
4% Seed

Non-food uses of wheat are so small that they don't even include them in the total.

So, excluding exports, 72% of wheat used in the U.S. goes to feed people, 20% to livestock, and 8% is saved for seed.

http://www.kswheat.com/consumerspageid261_uses-of-wheat.shtml

But the WHO figures I cited all purport to report per capita human consumption of wheat as food or alcohol.

The data on the Trappists, Yemenites, and Bedouins all refer to actual bread consumption.

I'm not aware of any non-food use of wheat in France (or anywhere else) that would double their consumption.

http://www.fao.org/docrep/006/y4011e/y4011e04.htm

Ukraine has the highest per capita wheat consumption (437 kg/capita), followed by Kazakhstan (410) and Bulgaria (390). Ukraine beats France (242) by nearly 200 kg, Bulgaria by nearly 150 kg. Agrarians eat lots of grains.

Jimmy Gee said...

"Here's what I would say: We have an enormous and growing body of data that supports the lipid hypothesis. It is the best supported explanation for cardiovascular disease over the past 60 years or so."

I guess all the contrary evidence cited by people like Gary Taubes, the Eades, Kurt Harris and William Davis to name a few, is meaningless? If the evidence is so strong, then why do people show significant improvement in cardiovascular disease markers when increasing saturated fat consumption and reducing / eliminating breads and sugars? I would also point you to another doctor - Dr. Mike Nichols (whenyouareserious.com)who actually measures risk factors in patients following lifestyle changes that exclude wheat/grain products and include animal protein/fat.

--------------------------------
"The data is strong enough to say that diets high in sugars, fats and animal protein promote diseases of affluence, whilst diets low in sugars, fats and animal protein protect against those diseases. "

So which is it lipids or sugars or proteins?

---------------------------------
"This is science. The epidiemiology suggests that wheat is a protective factor. So Groen does a clinical trial and confirms that a diet high in wheat reduces risk factors."

This isn't science, it's generalization. Observations of monks etc.. don't show cause and effect. If "bread eaters had low serum cholesterol", so what. There is a large amount of evidence that disputes serum cholesterol as a relevant risk factor. Also, saying these groups have "very low risk of ischemic heart disease" and actually proving it are very different propositions.

Don said...

Jimmy Gee,

As I said, the BULK of data supports the lipid hypothesis. The reason we rely on a BODY of evidence is that there will always be 'noise' in a system like science, outligher data, rigged studies, botched studies, etc. If the bulk of evidence points in a certain direction, then most likely contrary data represents poorly designed studies, confounders, and other 'noise.'

"If the evidence is so strong, then why do people show significant improvement in cardiovascular disease markers when increasing saturated fat consumption and reducing / eliminating breads and sugars?"

So is it eliminating the sugars or the bread that produces the results in the cases you are referring to. If both are eliminated/reduced you have no way of telling which was the effective factor...

Unless you do what Groen did in the study I cited. He varied both bread and sugar intake, and showed that increasing bread while reducing fat and protein improved risk factors, while replacing bread with sugar worsened risk factors.

Again, the bulk of evidence I have seen indicates that people show improvements in IHD risk factors when their low carb diet is also low in energy (low calorie), but not when their low carb diet is eucaloric or hypercaloric.

It is lipids and sugars. We literally have thousands of studies (epidemiological, case-control, and clinical trial) showing that diets high in lipids (fats, oils, and cholesterol) increase cardiovascular disease risk factors including effects on cholesterol levels, clotting factor levels, inflammation, endothelial function, and blood sugar levels. We also have dozens showing that diets high in refined sugars can increase risk factors.

Jimmy Gee said...

Sorry Don, I don't buy it. The Groen paper is a 1967 dated document that focuses on "serum cholesterol". The changes reported are physiological responses to dietary changes. So,I guess if you read into the paper, you might try to make the leap and revive the old "lipid hypothesis" which even members of the AHA and the Framingham study have suggested may not be accurate.

Doesn't seem like science to me.

Don said...

Jimmy Gee,

"This isn't science, it's generalization. Observations of monks etc.. don't show cause and effect. If "bread eaters had low serum cholesterol", so what. There is a large amount of evidence that disputes serum cholesterol as a relevant risk factor. Also, saying these groups have "very low risk of ischemic heart disease" and actually proving it are very different propositions."

First, generalization is a part of science, provided evidence supports generalization.

When scientists say that a group has a very low risk of heart disases, they often mean that the group has a very low incidence of heart disease. For example, the Trappists, Yemenites, and Bedouins discussed by Groen all have a very low incidence of ischemic heart disease. Very few (a very low % of) individuals in these populations get the disease.

You obviously did not read Groen's article. He performed a clinical trial in which he varied the amount of bread, animal protein, fat, etc. to determine the effects on serum cholesterol.

Let me explain his scientific process once again. First, he observed that the Trappists etc had diets high in bread and low in fat and animal products and low cholesterol levels and low incidence of heart disease. From this he generated the hypothesis that a diet high in bread reduces cholesterol levels. To test this hypothesis, he performed a clinical trial of diet variations revolving around varying the bread content. His trial showed that the diet high in bread reduced cholesterol levels. This finding confirms the observed link between diets high in bread and low cholesterol levels and low heart disease incidence. It lends support to the hypothesis that diets high in bread and low in animal products (and sugar) protect against heart disease.

If many different scientists perform similar studies that have similar results, the evidence supporting the hypothesis grows. This is exactly what has happened.

There is no comparably large body of evidence disputing the relevance of cholesterol as a risk factor.

Flat out, serum cholesterol, especially LDL, is a major risk factor for ischemic heart disease. Once your cholesterol rises above 150 mg/dL, your risk increases in virtually a dose-response fashion.

But in Western nations where almost everyone has a cholesterol over 150 mg/dL, it is difficult to detect the difference in risk. The risk for someone with a TC of 200 is similar to that of someone with a TC of 240, because both are well above the threshold for effect.

In other words, 150 is the threshold for the ill effect of serum cholesterol. Once a person passes that threshold, they are in the high risk category. This is why a high proportion of heart disease occurs in people with cholesterol under 200, a fact misinterpreted by the low carb community to mean that serum cholesterol doesn't matter.

WoLong said...

Thanks Don for the clarification. You have a nice blog, it ruffles some people`s feathers the wrong way, but hey one can`t keep everyone happy.

Jimmy Gee said...

"You obviously did not read Groen's article. He performed a clinical trial in which he varied the amount of bread, animal protein, fat, etc. to determine the effects on serum cholesterol."

Actually, I did read the article. What is not in the article is a reporting on the specific blood lipids / fractions. What is being reported - HDL, LDL... who can tell from this paper? Nor is there a good accounting of diet / food selection. Also, the article makes a leap in logic from low rate of IHD in the study population to low serum cholesterol as the putative cause. Perhaps you should re-read the article.

"Flat out, serum cholesterol, especially LDL, is a major risk factor for ischemic heart disease. Once your cholesterol rises above 150 mg/dL, your risk increases in virtually a dose-response fashion. "

What is your reference for this?

IHD isn't about serum cholesterol but specific blood lipids or more so, their rate of utilization / degeneration.

It is no surprise that displacing specific nutritional components (fats) by substitution with wheat will affect lipid profile. What is surprising is that such a leap of logic (or lack of logic) is being reported given current research findings.

Bog said...

"What is your reference for this?"

Dude, this is basic mainstream stuff. Here's the guy from Framingham you recited.

Interview with William Castelli. 150mg/dl cholesterols is the only safe treshold.

"You know, we know that if I can get your total cholesterol down around let's say 100 to 130 or so, and I have maybe not quite a billion people on the earth like that, and those people cannot get atherosclerosis. You know in the China Study, for example, when Chou En-lai was dying of cancer he started a study in China just like the Framingham Study. The only difference was it was in 880,000,000 people so it was a little larger than the Framingham Study. But you know they found these villages in China where you couldn't get a heart attack or you couldn't get diabetes and the women couldn't get breast cancer and you know their total cholesterol were 127, but the chances we could ever get Americans down that low with diet and exercise are not good"

http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

As far as I know there's not a single heart surgeon in the US who has operated a patient with cholesterols under 150mg/dl,

according to the chiefeditor of American journal of cardiology, William Roberts, you are basically bullet-proofed from heart-disease with digits under 150mg/dl

http://www.youtube.com/watch?feature=player_embedded&v=bY0UY3FwoW4

WoLong said...

I am baffled by many Paleo devotee's approach to science. No wonder they are called paleotards. They would gladly cite people with no or very shaky credentials (Taubes, Davis, Eades, De Vany) while brushing aside peer-reviewed journal publications. I would note that journal publications usually have much severe peer review processes than book publishing.

Jimmy Gee said...

To Bog and Wo;

If that's the best rebuttal you can muster (including name-calling "paleotard" - really??) well then good luck to you and your blind following of Don's wisdom. Enjoy your wheat and keep the blinders on.

WoLong said...

If the word “paleotard” offends people, I apologize and take it back. I also want to say that I don’t agree with Don on a lot of things. I have zero belief in Chinese medicine, yin-yang, acupuncture, etc as I don’t think these have any science behind. But I visit this blog from time to time because, well, it’s sometimes entertaining and offers some contrarian views to many others.

Don said...

Jimmy,

"Doesn't seem like science to me."

If not science (study of the natural world), then what is it?

"What is not in the article is a reporting on the specific blood lipids / fractions. What is being reported - HDL, LDL... who can tell from this paper?"

The study was of the effect of bread on SERUM CHOLESTEROL, not subfractions.

"Nor is there a good accounting of diet / food selection. Also, the article makes a leap in logic from low rate of IHD in the study population to low serum cholesterol as the putative cause."

It doesn't make a 'leap,' it attempts to discover and report the effect of a diet high in bread on serum cholesterol.

If you read the literature, subfractions do not matter if your total cholesterol is under 150 mg/dL. There really is no good evidence that, e.g., a high HDL will protect you if you have a high total cholesterol. And if you have a low total, it does not matter if you have a low HDL (which of course you will have since all subfractions are at low levels when you have a low total). Bog gave more details.

"Epidemiological studies show that HDL-cholesterol levels are inversely correlated with the risk of cardiovascular events. However, many patients who experience a clinical event have normal, or even high, levels of HDL cholesterol."

Nature Reviews Cardiology 8, 222-232 (April 2011)
http://www.nature.com/nrcardio/journal/v8/n4/full/nrcardio.2010.222.html

"good luck to you and your blind following of Don's wisdom. Enjoy your wheat and keep the blinders on."

How do you come to conclude that they are 'blindly' following anyone? Since they disagree with you, you consider them blind?

I wonder if you can provide some good scientific evidence that wheat causes heart disease?

Please enlighten me if the 'wheat hypothesis' has a body of supportive evidence comparable in size and quality to that supporting the 'lipid hypothesis.'

If the evidence in favor of the wheat hypothesis is so strong, and that for the lipid hypothesis is so weak, I wonder why no major scientific medical organization in any nation advocates the 'wheat hypothesis' and the lipid hypothesis holds sway.

Don said...

Wo Long,

Do you know the spectrums of hot/cold, dry/wet, fast/slow, male/female, light/heavy, day/night outside/inside, primary colors, differences between plants and animals?

If so you KNOW yin-yang as a fact of your experience, even if you don't 'believe' in yin-yang.

Yin is a category term used to refer to all things that we experience as cool-cold, moist-wet, dark, green-blue-black, soft, smooth, slow, inert, internal, and similar overlapping qualities. Yang is a category term use to refer to all things that we experience as warm-hot, dry, bright, yellow-orange-red, hard, rough, fast, active, external, and similar overlapping qualities.

It seems to me that the recognition of these aspects of our experience is the very basis of science.

Saying you don't 'believe' in yin-yang is like saying you don't believe there is any difference between hot and cold, male and female, dry and wet, etc.

Chinese medicine is not a faith system. It is a science, based on observation, hypothesis, and experiment. It consists traditionally primarily of using natural materials (from plants, animals, minerals, etc) as medicines. If you do a little research, you will find that Western medicine also uses natural materials. Aspirin was derived from willow, penicillin from mold, estrogens come from animals, and the list goes on.

If you are hot and thirsty (dry), do you remedy it with barbecued pork, or watermelon?

If you choose watermelon, you practice rudimentary Chinese medicine: treat yang (hot and dry) with yin (cold and wet).

Teech said...

I can't tell if you if wheat by itself causes anything, but I can say that for me it has caused many problems, and I don't have celiacs. My problem with all of these dietary websites trying to prove something wrong or right is that it is so black and white. Wheat bad vs wheat good, meat bad vs meat good, fat bad vs fat good, carbs bad vs garbs good and so on and so on. Individuals defend certain foods as sacred and balk at the thought of ever denying themselves that food. As a responsible dietary advisor you should be able to separate yourself from the food because for many people wheat is an issue, just like dairy, meat, soy, shellfish etc. Its exhausting seeing people work so hard to confirm their own beliefs. I used to tell people to eat their "whole grains" without ever considering their physiology or my own. I was so wrapped up in wheat that I could not imagine life without it, until I tried it. So my points is, if you found yourself doggedly defending a food, give it up for a while and goback to it if you don't notice any difference. I've given up dairy and meats at one point in my life and found that I actually did better on them, but this may not be true for others. Also we can't forget the other variables like food quality and toxins in the food which may affect the results.

Oh and what about the zoo gorillas that were getting heart disease from a high carb vegan diet?

Steve

Don said...

Steve,

Some people are saying that wheat makes people fat, diabetic, and prone to heart disease. I am only providing the evidence that for the vast majority of people this is not true.

Of course people who have celiac disease or intolerance to wheat should not eat it. But this is a rather small minority of the population, less than 5%. The fact that some people like yourself have ill effects from eating wheat does not mean that every 'responsible' dietary advisor should tell everyone to be careful with wheat.

"Oh and what about the zoo gorillas that were getting heart disease from a high carb vegan diet?"

Man you like to pack together a bunch of concepts to try to tarnish all with one brush.

Wild gorillas are virtually vegan making no deliberate effort to eat animal foods, andn are free of heart disease. So you can't blame a vegan diet for the heart disease of zoo gorillas.

A wild gorilla may eat a lot of fruit as well, so its not 'high carb' dieting that harms them.

Science Daily reports:

"After Brooks, a 21-year-old gorilla, died of heart failure at Cleveland Metroparks Zoo in 2005, Less and other researchers here took a hard look at how the animals' lifestyle affects their health. Less now leads an effort to counter the killer disease by returning the primates to a diet more akin to what they'd eat in the wild.

Gone is the bucketful of vitamin-rich, high-sugar and high-starch foods that zoos used for decades to ensure gorillas received enough nutrients.

Instead, Cleveland's Mokolo and Bebac receive a wheelbarrow of romaine lettuce, dandelion greens and endive they gently tear and bite, alfalfa hay they nimbly pick through, young tree branches they strip of succulent bark and leaves, green beans, a handful of flax seeds, and three Centrum Silver multivitamins tucked inside half a smashed banana."

Still on a vegan diet, but no longer processed, high-sugar gorilla-chow.

Moreover, you can't make conclusions about what humans should eat based exclusively on what gorillas need to thrive. A gorilla has a gut substantially different from a human, it is a hindgut fermenter capable of deriving energy from fermentation of cellulose. We don't have that capacity.

These gorillas don't prove that a vegan or high starch diet is bad for most humans. We have a huge amount of evidence that a a high-starch, low animal product diet not only prevents but reverses heart disease in humans.

Most of us come from a long line of starch eaters. My European ancestors lived on wheat, rye, barley, lentils, peas, millet for thousands of years. And they didn't have the diseases now prevalent in modernized nations so long as they lived on those starch-based diets. Most Asians lived on (and still live on) diets consisting largely of rice, millet, and wheat; most Africans on diets consisting largely of millets and other grains; native Americans lived on corn, beans, squash, and potatoes.

One point of this post is that historical data clearly shows that the modern American diet contains much less starch that traditional diets, and that starch-based diets are not some new experiment in human nutrition, but the traditional way of eating for much of humanity for thousands of years.

Don said...

here's the link to that quote I got from Science Daily:

http://www.sciencedaily.com/releases/2011/02/110217091130.htm

bongo said...

Hey Don,

I like to stop by your blog from time to time...good stuff.

I wonder what diet you advocate or are eating now? Are you completely vegan or do you eat eggs and small amounts of lean meats?

A post after the "farewell" post had some ground meat if I recall correctly. Have you further evolved to more of a vegetarian diet? If so, how has it been treating you and what are the changes in your heath? Thanks

Jimmy Gee said...

Bog (and Don you can read it too):

I'm not referring to Castelli I'm referring to another study director - Dr. Willam Kannel. The excerpt below was found and reported by Dr. Eades in his blog. It is taken directly from a Framingham report.
__________________________________
"The project was undertaken between the years 1957-1960 and involved a sample of around 1000 participants who were to be studied over the following 36 months to test the hypothesis that “The regulation of the level of serum cholesterol and the development of coronary heart disease are related to

1. The caloric balance
2. Level of animal fat intake 3. Level of vegetable fat intake
4. Level of protein intake

In undertaking the diet study at Framingham the primary interest was, of course, in the relation of diet to the development of coronary heart disease (CHD). It was felt, however, that any such relationship would be an indirect one, diet influencing serum cholesterol level and serum cholesterol level influencing the risk of CHD. However, no relationship could be discerned within the study cohort between food intake and serum cholesterol level.

In the period between the taking of the diet interviews and the end of the 16-year follow-up, 47 cases of de novo CHD developed in the Diet Study group. The means for all the diet variables measured were practically the same for these cases as for the original cohort at risk. There is, in short, no suggestion of any relation between diet and the subsequent development of CHD in the study group…

With one exception there was no discernible association between reported diet intake and serum cholesterol level in the Framingham Diet Study Group. The one exception was a weak negative association between caloric intake and serum cholesterol level in men. [As to] coronary heart disease–was it related prospectively to diet. No relationship was found.
__________________________________

Interestingly, Kannel felt the need to downplay these findings. Again a case of a researcher that is afraid to expose conventional wisdom for its flaws.


Also, regarding your sttement -
"As far as I know there's not a single heart surgeon in the US who has operated a patient with cholesterols under 150mg/dl, "

I have read internet accounts of Doctors encountering both "low" cholesterol heart attack patients and "high" cholesterol healthy patients. So....

Peter said...

@Jimmy

you have adjust to the fact that almost every single cholesterol study done in the last twenty years has to perceived in the statin context. Usually it's someone who has been on lipid lowering drugs for ten years, then dies with serum cholesterols showing 170mg/dl.

As said, there's enough data to convince me that you are basically immune for heart-disease with total cholesterol under 150mg/dl. According to William Roberts, you can stress, smoke and drink as much as you care for, you won't be getting heart-attack with the digits under the threshold.

This fact is nicely illustrated not only epidemiologic data but also in the clinical work of Ornish and Esselstyn. None of their patients who maintained their total cholesterol under 150mg/dl have gone through another cardiovascular malfunction.

If you interested to learn more, why not check primitivenutrition videos 43-45, 40-41 & 38. They're all about the cholesterol denying buffoons and their cheap reasoning.

Lisa said...

Don, your yin/yang description appeals to me After LF vegetarianism in my 20's and HF/LC paleo in my 30's, now I'm seeking balance. I want everything that meat, veggies, grains, beans and fruit have to offer. In a balanced way.

Are you soaking/sprouting/souring your grains and beans? I really want to do the bare minimum food processing to retain my health.

Jenny said...

I just saw this today:

Archaeologist Unearths Earliest Evidence of Modern Humans Using Wild Grains and Tubers

http://www.sciencedaily.com/releases/2009/12/091217141312.htm

Dating back more than 100,000 years, as opposed to the previously thought 10,000 years.

Jimmy Gee said...

@Peter,

"As said, there's enough data to convince me that you are basically immune for heart-disease with total cholesterol under 150mg/dl. According to William Roberts, you can stress, smoke and drink as much as you care for, you won't be getting heart-attack with the digits under the threshold. "

What about "all-cause mortality"? Heart disease is but one modality. How about increased risk of cerebrovascular events with so-called "low cholesterol". This has been reported in the literature as well. Who's to say that people that have serum cholesterol <150 throughout life even live long enough to have a heart-attack.

Plots of statistical distributions are out there showing nearly identical serum cholesterol level overlap when comparing incidents for populations with CHD and without.

People need to move on from the incorrect assumption that serum cholesterol is a direct cause of CHD. It may be a marker of a metabolic issue that in-turn may or may not affect cardiovascular health. However, it in itself is not definitive. If you take the time to review the literature and actually look at both sides, it is quite clear that the lipid hypothesis is crumbling as it was promoted by Keys.

I would suggest people spend some time reading scientific reviews by people like Chris Masterjohn, Denise Minger and Kurt Harris. They offer perspectives that make a lot more sense.

Will said...

Hi Peter,

"As said, there's enough data to convince me that you are basically immune for heart-disease with total cholesterol under 150mg/dl."

It's very unlikely, but still possible. Nine of the people screened for the MR FIT trial had cholesterol under 150mg/dL and died of heart disease.

Peter said...

^Most of smokers do not get lugn cancer, it's just that so many do, even if this fact would be hard to demonstrate in short-term controlled trial. Same applies for those who do not wear safety belts in the car, most of them makes it just fine. I just wouldn't take the risk, why? collision/sympton- free lethal cardiadic event

Hunter-gathers have very low cholesterols, even the heavy meat-eating ones, so what is the fuss? It's just unlike thst you are going be infected with parasites and endure long-term on a low-calory fare which are both capable lower you serum cholesterols. Therefore, I suggest you rather emulate low-cholesterol guaranteed diet of the millions in Central-Africa, rural Asia, the Andes, etc. Much safer bet, and much cheaper and ecologically feasible bet.

Peter said...

^Jimmy

sorry, I misread your post. You have account for the fact that all cholesterol studies don in the last 20 years must seen through the statin context. They only screen patients who've been on lipid-lowering drugs for years without adjusting to any life-style changes. So it's possible you suffer from a heart-disease with artificially lowered cholesterols, even if under the 150mg/dl. However, I doubt this would be the case once you combine both statins and life-style/diet related factors.

In the Framingham study with chohort of thousands, nearly no one has experienced cardiocvascular event with serum cholesterols under 150mg/dl. This study is not a statin context study. We see this clearly on epidemiologic studies as well, which, despite some short-comings, are much more powerfull as opposed short-term trials, which rarely enhances our understanding of the world.

Will said...

Hi Peter,

The point of my comment was simply that cholesterol levels below 150mg/dl is not a 100% guarantee, as certain people like Esselstyn lead people to infer.

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Peter said...

Will,

Esselstyn didn't make it, he just read the literature. Esselstyn himself only applied the hypothesis in practise, and so far success rate 100%. I don't know anything about the trial you are referring to, could you please inform me about the context. In Framingham study there's few few chaps who've had heart attack with total cholesterols under 150mg, these had the so called high triglycerides/low HDL -syndrome. However, to put things in correct context, you are disease proof with digits under 150mg/dl, and no genetically challenged exception is enough to contradict this powerfull notio backed by sounds data.

It's not rocket science, as Castell puts it.

"KIRK HAMILTON: But what would the diet be if you didn't have drugs and you could get everybody to do exactly what you wanted diet-wise in the United States? How would you reverse the heart disease?

DR. WILLIAM CASTELLI: Well you'd have them on a pure vegetarian diet and not getting fat on the vegetarian diet".

http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

Peter said...

Ouh..I think Esselstyns refers to the same study you were talking about (page 40). That study was just a drug trial without dietary component, and those who got their cholesterols under 150mg/dl with statins did very well, but it wasn't ofcourse a complete success. One of out of four of these under the 150-patients had eventually a new cardiovascular event.

As William Roberts, the chief editor of American journal of cardiology once cleverly put it, "only strict vegeterians do not need statins, the rest of us do". If you keep being silly and act like some imaginary meat-poundering grok and believe the charlatan choir out there, you end up some day on statins yourself. It's up to you, be smart, don't be a retard

Will said...

Hi Peter,

Way to accuse me of being a silly "meat-poundering grok" when all I pointed out was that _nine_ people (actually out of hundreds of thousands!) died of heart disease with very low cholesterol. This means it's not a total guarantee. Period. That's all I'm saying.

I do not dispute the fact that CVD risk goes way down below 150mg/dL. But you seem to write as if I did.

BTW: Just because I'm not veg*n does not mean I eat paleo, or even that I eat a meat-dominated diet. Where did you get that idea? Not all omnivores eat Atkins-style, you know :)

You'll excuse me if I find Roberts' last quote rather silly: "only strict vegeterians do not need statins, the rest of us do." Tell that to all the centenarian omnivores. Or Okinawa and other blue zones. I believe most RDs would agree that it's simply not necessary to be 100% strict vegetarian to be healthy. There are plenty of people living on the planet _today_ refuting this idea.

Peter said...

What's the point of having Okinawa folk as your point of argument for against of not being a veg, when in fact traditionally Okinawa folk sustained almost exclusively on plants. You ain't be eating much animals if you want to have your fat intake around 6% as the Okinawan people traditionally had.

If only 9 people out of hundred of thousands get a cardiovascular event with cholesterols under 150mg/dl,I consider it to be pretty darn validating for my argument. After all I am speaking about getting your cholesterols under 150mg/dl level through dietary means, not through statins. In one Chinese chohort there were over 800 000 people and not single one had a reported cardiovascular event, practically everyone had their cholesterols under 150mg/dl, most had much lower.

Will said...

Sigh. I feel like I'm talking to a wall :)

Okinawans are not "strict vegetarian," that is the point. In fact a vast majority of healthy cultures are not strict vegetarian. Sorry, but that's the way it is. The fact that they eat a majority of their diet as plants doesn't detract from this point. Sardinians eat meat once a week - would you call them 'strict vegetarian'? These people are better described as flexitarian.

"If only 9 people out of hundred of thousands get a cardiovascular event with cholesterols under 150mg/dl,I consider it to be pretty darn validating for my argument."

Re-read my comment. I take issue with the idea that 150mg/dL *by itself* makes it completely impossible to get a heart attack, because it does not. Are you and I really in fundamental disagreement here? If you're going to just repeat the same thing again and again, don't bother. We're going in circles :)

Peter said...

Will,

your stubborness turns into a nuisance. Let me help you.

We don't tell people it's okay to drive without the seatbelt despite you may still die in a an accident even if you wore the seatbelt.

Is there something in the sphere of science that is 100% guanteed. No. That is why clever people have come up with the idea that we go after things that are close to 100% guaranteed, like 99,9% guaranteed. And one of those things included is the advice to keep your cholesterols under 150mg/dl which gives you (close to 100%) guarantee against heart disease. Get it.

Will said...

Peter,

Your last comment has basically proven that we agree fundamentally, except that you for some reason don't want to admit it... lol.

I see this as a pointless argument, as it has devolved into bickering. I can't treat it seriously anymore. Apologies Don, for taking this space to debate an off-topic issue with Peter.

Peter said...

^Why not just thank me for introducing you to life-saving information.

Will said...

Peter, give it a rest. I think you're just bitter that I eat animal foods, and that your orthorexia prohibits you from doing the same :)

It's ok. Have some sushi (shock! horror!) and relax. Seems to be working for the Japanese, you know?

Mark Shields said...

Ok, so "no one would have a heart attack with cholesterol under 150"... yet, they would have a much greater risk of cancer, strokes, mental issues.... pick your poison I guess. How anyone after reading "Good Calories, Bad Calories" can still hold onto the low-fat/cholesterol myths is beyond me.

Add on that what do you think our bodies we're meant to run on? Sometimes when it comes to nutrition, simple logic should prevail.

Don said...

Mark Shields,

The issues you list are LESS common among populations with cholesterol under 150 mg/dL. Check, for example, the Chinese and the Tarahumaras.

'Good Calories Bad Calories' did not overturn some 50 years of research supporting the lipid hypothesis.

Both history and nutritional biochemistry indicate that humans are well adapted to diets consisting largely of starch. Our protein requirements are quite low (5% of calories; human breast milk provides only 5% of kcal as protein at a time of extremely rapid lean mass growth) and so are our absolute fat requirements (30-50 g / 270-450 kcal per day).

Will said...

Hi Don,

Let me preface this comment by saying I agree that we are well-adapted to starch-based diets, but your chosen evidence for this is peculiar to me.

For example, one could say that our carbohydrate requirement is low because we can make all the glucose we really need. So this particular line of reasoning makes it look like a virtual wash for any of the macronutrients.

Also, human breast milk consists of 35-40% carbohydrate, and most of that is in the form of lactose - a simple sugar. This is hardly a compelling example of a 'diet consisting largely of starch.' Paul Jaminet in fact uses this as evidence that a low(er) carb diet is optimal.

Don said...

Will,

"...one could say that our carbohydrate requirement is low because we can make all the glucose we really need."

To 'make' glucose we need a substrate. If not starch, then protein. It is very clear that we have a limited tolerance for this process which produces abundant toxic by-products sulfuric acid and ammonia. Only about 50% of dietary protein can appear in the blood as glucose. This means one has to consume 200 g of protein to get 100 g of glucose, 300 g of protein to get the 150 g of glucose that is the typical requirement for the nervous system and RBCs. This means you have to consume 1200 kcal of protein to get 600 kcal of glucose. This is a very inefficient way of subsistence.


Mother's milk is so misunderstood. You can't uncritically use mother's milk as a model for adult nutrition because there are very important metabolic differences between adults and infants. Infants have a metabolic rate 2-3 times that of an adult, i.e. they require, on a weight basis, 2-3 times as much energy (calories) as an adult. In such a circumstance, fat is a preferred energy source, because it supplies 2.5 times as many calories per gram as carbohydrate. A low-fat milk with an appropriate water content would have too low of an energy density for the needs of an infant, i.e. the infant would not be able to consume enough energy in a day if the milk was too low in fat.

When we leave infancy, we leave behind the need for highly concentrated sources of calories.

We also leave behind the infant's protein requirement, which is on a weight basis more than twice that of an adult, because we stop gaining lean tissue at the rate of an infant (doubling in weight every 6 months or so).

But we don't leave behind the need to avoid using protein for energy.

To prevent the use of protein for energy, mother's milk supplies about 7 times as much carbohydrate as protein. This suggests that the adult diet should also have about 7 times as much carbohydrate as protein.

Lactose is a disaccharide. Again, it has special functions for infants, such as increasing mineral absorption and promoting healthy gut flora growth. Moreover, this is a evolutionarily conserved feature of mammal's milk, i.e. it is in every mammal's milk, including that of animals that as adults are carnivores that consume essentially no carbohydrate, e.g. cats. I don't think we can conclude that adult lions have a carbohydrate requirement, on the basis that cat milk supplies kittens with lactose.

Don said...

By the way, cat milk is about 11% protein by weight, and dog milk is about 10% protein by weight, whereas human milk is only about 1% protein by weight. Human milk is about 7% carbohydrate by weight, while cat and dog milks are only 3-4% carbohydrate by weight.

Cow milk is only about 3% protein, but is considered to have too much protein for human infants:

"Infants fed cow's milk receive much more protein and minerals than they need. The excess has to be excreted in the urine. The high renal solute load leads to higher urine concentration during the feeding of cow's milk than during the feeding of breast milk or formula. When fluid intakes are low and/or when extrarenal water losses are high, the renal concentrating ability of infants may be insufficient for maintaining water balance in the face of high water use for excretion of the high renal solute. The resulting negative water balance, if prolonged, can lead to serious dehydration."

http://www.ncbi.nlm.nih.gov/pubmed/17664905

This seems to indicate strongly that the cat, dog, and other natural carnivores are equipped to handle very high protein intakes from birth onward. Of course, an animal adapted to hunting for a living should be adapted to very high protein intakes from birth onward, because most wild animals available for hunting have lots of lean meat and little fat.



My point about CHO in cat milk vs. CHO needs of adult cats is only to illustrate that infants of a species have different needs than adults of that species, so we can't uncritically jump from the composition of a species' milk to the nutritional requirements of the adults.

Don said...

In the case of humans, we have several lines of evidence that we are adapted to diets containing substantially (~7 times ) more carbohydrate than protein: mother's milk has that ratio despite the high protein requirements of the infant; adult protein requirements decline substantially compared to infants, if the diet contains carbohydrate; we are very inefficient at producing carbohydrate from protein; and yet we have a higher basal carbohydrate requirement than species having smaller brains (relative to body and gut mass) such as chimps and even moreso, cats. The human nervous system uses 2/3 of total basal energy requirements and 1/3 to 1/2 of basal carbohydrate oxidation. No other species burns anywhere near this amount of glucose on a daily basis. To me it is beyond belief that a species would evolve a nervous system that uses glucose as its default fuel while eating a diet low in glucose or that requires wasting 50% of dietary protein to get that precious fuel.

So using the 7:1 CHO:PRO ratio of mother's milk, an adult needing ~50g protein daily would eat 350g carbohydrate.

I am not aware of any evidence that any non-human naturally carnivorous species (e.g. cats) ever drove any of its prey base to extinction by over-hunting. When natural carnivores hunt, they take few animals, and almost always the weak, old, or sick, i.e. those that can't get away fast enough. This strengthens the herd by weeding out the least fit animals. It is very unlikely that a typical carnivore, which hunts prey animals one-by-one, could ever drive its food base to extinction.

By contrast, we have evidence the humans have driven some species to extinction. When humans hunt, they want the largest, fattest animals, i.e. the most reproductively capable ones. This desire to eat the largest, most impressive animals is actually an herbivore strategy, which delivers the most food for the least effort. In contrast, natural carnivores set their sights on the weakest, slowest, easiest animal to catch, not the fastest, strongest, because this will mean the least effort expended for a meal.

Further, because of our intolerance for high protein intakes (unlike cats), if we don't have plants available, we have to eat the fattest animals, or kill many animals at once, using only the fat from some while wasting the lean meat.

So, humans have a prehistory of killing animals en masse, a process that very quickly leads to herd extinctions. But when humans try to depend on hunting, they have to hunt this way because we are so protein-intolerant (unlike true carnivores).

To me this indicates that humans are, unlike cats, NOT metabolically (nor psychologically) adapted to a hunting based diet. I don't believe that a species can be said to be adapted to a way of eating, when the nutritional requirements of that species dictate that, to sustain that way of eating, it must destroy and drive to extinction its food base.